* individual's appraisal (preception) of the emotionally hazardous sitation greatly determines both the occurance & seriousness of the crisis

*more seriously threatening an individual's appraisal of an event, the greater the likelhood for primitive of coping behaviors.

*person in crisis tend to pull away from contact with "significant others" Positve interpersonal relationships tend to foster positive resolution of a crisis, while lack of interpersonal contact tend to lead to a slower or less adaptive outcome

Potential Crises:

death + survivors= heighten need for intervention counseling:

Suicide

Homicide

A.I.D.S.

S.I.D.S.

Suicide Homicide A.I.D.S. S.I.D.S. grieving challanges for the above:

Cause

Investigation & Interrogation

Severity of Loss

Relational problems (family, marriage, siblings & significant others)

ABC Method (Stone)

Crisis- contact or establishing counseling relation

ship with person in crisis; establish rapport (trust & empathy)

*Attending behavior

*Listening

*Non-judgmental

Coping-

1. establishment of goals

2. inventory of resources

3. formulation of alternatives

4. review & refinement

5. action

*follow-up of the counseling process

*re-affirms your caring

*provides opportunity to deal with residue from the crisis

Boling (down the the problem to it's essentials)- responding, verbal and non-verbal to get a response, discover & understand real feelings, focus on the clients cause of problem to help reduce anxiety & stress level for the person in crisis; enhance self esteem

Aftercare

phone contact

personal contact-home visits

letter/cards-bereavement program

literature (pamphlets, books, audio-visual)

community education programs

professional after-care programs

referrals to support groups or professional therapists

where counseling takes place

most often in funeral homes the idea of making a family feel comfortable & secure as possible in the main concern helping them see the counselor as their source of resource--their security blanket.

arrangement room should be pleasant, comfortable & private with the director sitting apart of the group paying attention to the details of the person participating and not simply to oversee the process. Asking alot of questions to fill out the forms.

post-funeral counseling giving the funeral director counselor a pivotal spot to become the primary or referral counselor for families of different cultures and various life styles. Making contact with the family 10 days to 2 weeks following the funeral & again at a later date. Seeing each and every encounter at church, in the business or social world as a potential counseling situation for repeat business.

At Need Counseling

Definition: a death has occurred & the funeral director is counseling w/ the family as they select the service & items of merchandise in completing arrangements for the funeral service of their choice.

At Need Counseling Steps

1. Need or problem defined-the proper care of the body & its disposition, need of the family to be counseled "needs" "wants/desires"

2. Need or problem determined & verbalized- evident, unexpressed or completely unrecognized making it an evaluation procedure. Needing the counselor to say "tell me about it or what are your feelings?" making no assumptions

3. Resolutions & actions-review the needs for clarity, offer suggested viable options & discuss relative merits of ea. family. Give examples how others may resolve similar needs be suggestive in line with responsiveness never mandate.

4. Decision- lead those confusied to counsel to make the best decisions that will fullfill their needs & resolve their situations

Theories of Grief

Dr. Erich Lindeman--"Acute grief" or "Grief Syndrome"

John Bowlby--"Post-loss grief" or "Attachement theory"

Dr. Elizabeth Kubler-Ross-Five stages of Death & Dying

Dr. Erich Lindeman--"Acute grief" or "Grief Syndrome"

published 1944 article "Symptomatology & Management of Acute Grief"

most influential single piece of writing on physical expressions of grief

ideas from interviews & psychotherapy w/ bereaved families of victims of catastrophic fire at the Coconut Grove Night Club

1st person to introduce the term "grief syndrom" as a set of symptoms associated with loss.

Acute grief is a definite syndrome w/ psychology awarness increased of a loss appear of someone or something significant.

The Syndrome appear immediately after a crisis; may be exaggrated or apperently absent.

Their may be distorted pictures, each of which represent a special aspect of the grief syndrome.

Appropriate teccqniques the distorted pictures can be succesfully transformed into a normal grief reaction with resolution.

"Sensations of somatic distress occurring in waves lasting 20 mins to an hour at a time; feeling tightness in the throat; choking w/ shortness of breath; a need for sighing w/ an empty feeling in the abdomen; lack of muscular power & intense distress described as tension or mental pain"

Normal acute grief:

1. somatic or bodily distrubance of some kind

2. preoccupation w/ the image of the deceased, hallicinations

3. guilt

4. hostile reactions

5. inability to function as before the loss; changes in patterns of conduct

1st recognized & use the term "anticipatory grief"

mourning is recognized now as being more complex, that it's important to mourn and be apart of the grieving process to prevent a variety of emotional & physical alliments.

antisipatory death

a symptom characterized by the presence of grief in anticipation of death or loss. Actual death comes as an affirmation of knowledge of a life limiting condition.

1. Attachements come from the need of security (developed as a child)

2. emotional reactions from situations that endanger the bond of attachement

3. a greater potential for loss, a more intense reaction (clinging/crying)

John Bowlby--"Post-loss grief" or "Attachment theory"

theory based on "attachement theory"

-before one can fully comprehend the impact of a loss & the human behavior associated with loss; one must have some understanding of attachement.

1. Attachements come from the needs of security (developed as a child)

2. Rise in emotional reaction with situations that endangered the bond of attachement

3. intense reaction (clinging/crying) with a greater potential for loss

John Bowlby's 4 phases in the grief process

1. Numbing

2. yearning & searching for the lost figure

3.disorganization & despair

4. greater or lesser degree of reorganization

Dr. Elizabeth Kubler-Ross-Five stages of Death & Dying

"On Death & Dying" 1969 book has been widespread appeal about realizing that death is close to hand, people go through distinct psychological stages in the process of psychological response to dying.

These stagess are:

Denial

Anger

Barganing

Depression

Acceptance

Denial

when you discover they are dying from terminal illness or condition, initial response is to deny the inevitable event in order to cope with shock of finality.

Denial is to buffer unexpected shocking news

its a tempoary defense & is replaced by partial acceptance

it exist in nearly every patient & they should be allowed

they recuperate gradually from this state when the initial feeling of numbness begins to disappear & they can collect themselves but their usual response is "NO"

anger

After denial it's replaced by anger, the patient feels unjustly choosen for death.

its a different stage and it's directed in all directions

the questions of "why me?"

it can be directed towards the family, doctors, nurse & or God

barganing

over time they reach the stage when they want to strike a deal or bargin with death. They start to accept the inevitable but they start to look towards "extending the lease" to postpone death, most often with God, for more time to live as a reward for their "good behavior".

some say "I have things I need to do before I die"

depression

next stage after barganing moves a person into a depression over the loss of personal life. This important to prepare them for full acceptance of death. They replace anger & rage w a sense of great loss, allowing them to express sorrow. Crying is normal and they will need to feel loved & wanted

acceptance

finally they accept that they are going to die, they usually are void of feelings not of "giving up" but they are needing time to rest before the end comes, they might want to be left alone in silence at this time or for a specific good purpose. Hope is found in all stages of the copying mechanism this helps to nourish patiences during the difficult time.

J. William Worden-"The Four Task of Mourning"

1. Accept- the reality of the loss

2. Experience- the pain of grief & to express the emotions associated with it.

3. Adjust- to an enviroment in which the deceased is missing.

4. Withdrawl- emotional energy & reinvest in another relationship or emotionaly relocate the decased & move on with life.